Note:  In patients with congenital heart defects or in HCM there may appear a continuous murmur sound.  This begins in systole, peak near S₂, and continues into all or part of diastole.  This continuous flow is due to a communication between high-and low-pressure areas that persists through the end of systole and the beginning of diastole. 

Restrictive Cardiomyopathy - 

          The hallmark of the restrictive cardiomyopathies is abnormal diastolic function; while the ventricular walls are excessively rigid and impede ventricular filing.  Also, myocardial fibrosis, hypertrophy, or infiltration due to a variety of causes is usually responsible.  The cardiologist and/or electro physiologist can determine through a series of diagnostic exams which may include the specific roentgen (chest x-rays), nuclear imaging, and a transesophageal -echocardiogram. 

Note:  The Transesophageal-Echocardiogram (ETT) procedure allows the cardiologist to view the heart while it is moving and to observe its main pumping chambers, along with the shape and thickness of the chamber walls as well.  Through this unique procedure, it is also possible to determine the volume and direction of the blood flow cycle in the heart.  This assessment is especially important for the HCM patient to determine size, pumping strength, abnormal blood flow patterns, and structural abnormalities. 

          The myocardial involvement with the protein “amyloid,” once deposited in the heart muscle, kidneys, or nervous system, it cannot be broken-down, nor recycled by the body and will lead to amyloidosis.  The signs and/or symptoms that you may be observing will include: swollen legs and ankles, weakness, weight loss, shortness of breath, dizziness, diarrhea, severe fatigue, enlarge tongue, and numbness in the extremities.   Also, this is a common cause of secondary restrictive cardiomyopathy. ²⁸

     In many of these conditions, particularly those with substantial concomitant endocardial involvement, partial obliteration of the ventricular cavity by fibrous tissue and thrombus contributes to the abnormally increased resistance to the ventricular filling.  Thromboembolic complications have been reported in the U.S. in about a third of these patients. ²⁹    

Conclusion –   

     HCM may be characterized morphologically and defined by a hypertrophied, non-dilated LV in the absence of another systemic or cardiac disease that is capable of producing an abnormal wall thickening evident (e.g., systemic hypertension and/or valvular stenosis). Indeed, clinical diagnosis for the most part and cost saving measures remain today through an electrocardiograph (12-lead ECG) or an event recorder (AECG).  Plus a transthoracic 2-dimensional echocardiograph, and with a cardiac magnetic resonance imaging, by detection of otherwise unexplained abnormal LV function.  Also including evidenced-based suspicion that may be raised after clinical profiling and family screening is gathered.   

     Medical research institution across the world has open new pathways into genetic encoding, and ion channelopathies, both nocturnal and sudden unexplained death syndromes in pediatric and older adults, are investigated through mutations in defective ionic channel proteins and ion channel electrical disorders which include the LQTS, and/or short-QT syndrome.  Also notable, are the SQTS syndrome, and the Brugada syndrome which includes gene encoding.  These electro-physiological findings are making there way into the care of the trauma physician teams within North American and Southeast Asia. 

     Throughout this article, the author’s have strived to bring a useful  guideline towards the registered nurses and/or nursing practitioners, in order to enhance and encourage advance critical-thinking that she and/or he may act upon within a medical institution, outpatient walk-in clinic, or emergency room department. 

     Also, the authors would like to give their thanks to both learning institutions (Angeles College of Nursing and the advanced Continuing Nursing Education Department at Kaiser Permanente Health-Care Facilities for the advancement of applied nursing education and information.  Also, the physicians (e.g., interns, 3^rd year residence, and fellows), who are finishing their cardiology and electrophysiology services.  

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